Every thought and movement in your life occurs through your brain and spinal cord, which is collectively known as the central nervous system. Your spinal column acts as the armor and pathway for your spinal cord to travel down and split into the nerves that reach every cell of your body. Every moment, millions of messages and bits of information are moving along your spinal cord to maintain the delicate balance between your brain and body.

Let’s look at some research to back this up. A recent article published by Haavik et. al., looked at the effects of chiropractic care on changes in cortical intrinsic inhibitory interactions in patients with chronic neck and upper extremity pain by measuring dual somatosensory evoked potentials (SEP) in the median and ulnar nerves.

The number of participants in the study was limited, however, their results were significant. They found that there was a significant decrease in the ratio and amplitude for the SEP as well as a decrease in average pain levels for all of the participants following a chiropractic care plan that was specifically recommended to each participant based on their individual clinical findings. No changes occurred in measurements during the control period prior to beginning chiropractic care.

The authors concluded that “chiropractic care improved suppression of SEPs evoked by dual upper limb nerve stimulation at the level of the motor cortex, premotor areas, and /or subcortical areas such as basal ganglia and/or thalamus.” Of course, larger studies are needed to verify and confirm these results but is always the case with science and research.

So what does this mean to you and your chiro adjustment? Very simply put, chiropractic care improves neurological activity and function for patients with chronic pain, and not just on a local level at the site of the chronic pain – it improves the neurological activity and function deep inside the cortex of your brain and brainstem, and improves your body’s ability to effectively communicate information to your brain.

If chiropractic has this powerful effect on patients with chronic pain, it is not unreasonable to infer that it also has the same effect on acute pain and on people without any pain! So do not wait until you are in chronic pain before you start taking care of your spine and nervous system – be proactive in your health by making healthy lifestyle choices and having your spine checked and adjusted regularly.

Haavik H, Niazi IK, Holt K, Murphy B. Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual Somatosensory Input in Chronic Pain Patients: A Preliminary Study. J Manipulative Physiol Ther. 2017 Mar – Apr;40(3):127-138. doi: 10.1016/j.jmpt.2016.10.002. Epub 2017 Feb 10. PubMed PMID: 28196631.

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Currently thousands see the treatment of chiropractors however many don’t realise the wide variety of treatments a chiropractor can use to help relieve back and neck pain.  The article states “while the mainstay of chiropractic is spinal manipulation, chiropractic care now includes a wide variety of other treatments including soft tissue techniques, manual or manipulative therapies, postural and exercise education and ergonomic training – including nutritional consultations.  In addition, chiropractors often work in conjunction with G. P’s, pain experts, and other health professionals to treat patients with pain.

While this is nothing new to chiropractors, it may serve to further educate the public as to the many tools a chiropractor possesses to help patients.  While most of the research on chiropractic has focused on spinal manipulation, or adjustment of the spine, for pain relief, there have been studies done on the effectiveness of chiropractic for treating musculoskeletal pain, headaches, asthma, carpal tunnel syndrome and fibromyalgia (Harvard Health Publications).  The author goes on to state “a recent review concluded that chiropractic spinal manipulation may be helpful for back pain, migraine, neck pain and whiplash.”

Spinal manipulation, or adjustment of the spine, is a term used to describe providing a specific high velocity, low amplitude thrust to the vertebra to restore joint function.  Chiropractors use this technique to correct the body’s spinal alignment to relieve pain allowing the body to heal.  Treatment usually takes a short-focused period.  Most patients are scheduled 2-3 times a week initially.  Patients generally see improvement of their symptoms in the first 2 to 3 weeks (Harvard Health Publications).

References:

1. Harvard Health Publications (2015). Chiropractic Care for Pain Relief. Retrieved from http://www.health.harvard.edu/pain/chiropractic-care-for-pain-relief

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Why it Matters:

Each day we work with people, young and old, who are experiencing the symptoms associated with tech neck. By creating a plan of care that may include stretching, adjustments, and postural exercises; we have been able to help our patients overcome these aches and pains without giving up their mobile phones and tablets. 

• Looking down at your phone, tablet, or computer for long periods of time can cause muscle strains and neck pain which is now known as tech neck.
• Researchers have discovered the angle of your head when text messaging places tremendous amount of stress on your neck and spine.
• Taking short breaks to stretch at least every 30 minutes helps your body feel better by improving your posture and resetting your balance.

Next Steps:

Next time you are on the phone, stop for a moment and see if your head is creeping forward. If your chin is tucked down and your ears are in front of your shoulders, then you are in the forward head posture we call tech neck. It’s a good time to take a break, stretch, and reset. If you are experiencing any pain or headaches, then please reach out so we can work with you to create a plan to help you stay connected without suffering from tech neck.

Science Source(s):

Head flexion angle while using a smartphone. Ergonomics. 2015

Effects of a Resistance and Stretching Training Program on Forward Head and Protracted Shoulder Posture in Adolescents. JMPT 2017

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As your body heals from an acute episode of back pain, reducing inflammation is a key to a successful recovery. Dr Shaun from Cranbourne Chiropractic Centre says that if you choose the right anti-inflammatory foods, not only may you be able to quicken recovery but you may be able to reduce your risk of illness. Consistently pick the wrong ones, and you could accelerate the inflammatory disease process.

Foods that cause inflammation:

• Try to avoid or limit these foods as much as possible:
• refined carbohydrates, such as white bread and pastries
• French fries and other fried foods
• soda and other sugar-sweetened beverages
• red meat (burgers, steaks) and processed meat (hot dogs, sausage)
• margarine, shortening, and lard

The health risks of inflammatory foods
Not surprisingly, the same foods on an inflammation diet are generally considered bad for our health, including sodas and refined carbohydrates, as well as red meat and processed meats.

Some of the foods that have been associated with an increased risk for chronic diseases such as type 2 diabetes and heart disease are also associated with excess inflammation.

Unhealthy foods also contribute to weight gain, which is itself a risk factor for inflammation. Yet in several studies, even after researchers took obesity into account, the link between foods and inflammation remained, which suggests weight gain isn’t the sole driver.

Anti-inflammatory foods
An anti-inflammatory diet should include these foods:

• tomatoes
• olive oil
• green leafy vegetables, such as spinach, kale, and collards
• nuts like almonds and walnuts
• fatty fish like salmon, mackerel, tuna, and sardines
• fruits such as strawberries, blueberries, cherries, and oranges

Benefits of anti-inflammatory foods
On the flip side are beverages and foods that reduce inflammation, and with it, chronic disease. In particular fruits and vegetables such as blueberries, apples, and leafy greens that are high in natural antioxidants and polyphenols—protective compounds found in plants.

Studies have also associated nuts with reduced markers of inflammation and a lower risk of cardiovascular disease and diabetes. Coffee, which contains polyphenols and other anti-inflammatory compounds, may protect against inflammation, as well.

Anti-inflammatory diet
To reduce levels of inflammation, aim for an overall healthy diet. If you’re looking for an eating plan that closely follows the tenets of anti-inflammatory eating, consider a diet which is high in fruits, vegetables, nuts, whole grains, fish, and healthy oils.

In addition to lowering inflammation, a more natural, less processed diet can have noticeable effects on your physical and emotional health.

Source: Harvard Health Publishing

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Why it Matters:

Your skin is the largest organ in your body, and it’s loaded with small sensory nerve fibers that are responsible for proprioception. Placing tape in specific areas of your body across the skin provides sensory input that gives your brain more information as you move. This additional information has been shown to help improve balance, reduce pain, and support proper movement patterns.

• Tape worn on the skin provides your brain with more information about your movement patterns and can help reduce injuries and improve rehabilitation.
• Taping has been shown to improve balance for up to 72 hours after the tape has been removed.
• Researchers have found taping can be more effective than postural exercises alone to reduce neck pain.

Next Steps:

You can think of the tape less like a brace and more like a nervous system reminder that you wear on your skin. Not only does it look cool, but it has the potential to support better movement, reduce pain, and limit injuries. Now the next time you see an athlete wearing tape, you will know it’s more than just a fashion statement!

Science Source:

Extended use of Kinesiology Tape and Balance in Participants with Chronic Ankle Instability. Journal of Athletic Training 2016

Efficacy of kinesio taping versus postural correction exercises on pain intensity and axioscapular muscles activation in mechanical neck dysfunction: a randomized blinded clinical trial. The Journal of Sports Medicine and Physical Fitness 2017

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Why it Matters:

Driving a car, working on the computer, and using a tablet/phone all usually result in less than ideal posture. And when you start to lean forward, it places a tremendous amount of extra pressure on the discs in your neck and spine. This can cause increased compression and lead to pain. Even just a few inches of forward head posture can double or triple the amount of stress on the spinal joints in your neck.

• The average human head weights approximately 3.6-4.5kg.
• For every 2.5cm of forward head posture, an additional 4.5kg of weight is added to your spine.
• Forward head posture may result in muscle imbalances, a high risk for spinal degeneration, reduced range of motion, and pain.

Next Steps:

Take a moment today at work and notice if your shoulders are rounding, the head has moved forward, and upper back is hunched over. If you see yourself slouching into this posture, let us know. We would love to provide you with some exercises you can do at work to help strengthen the muscles supporting your spine and combat these muscle imbalances. And remember, the more time you spend in this posture, the more likely you are to suffer head and neck pain.

Science Source(s):

The Physiology of the Joints, Volume III. 6th ed. London: Churchill Livingstone; 2007.

Myofascial trigger points, neck mobility and forward head posture in unilateral migraine. Cephalalgia 2006

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Why it Matters:

Top researchers have found that specific movements of the spine, including the motion that happens during a chiropractic adjustment, can provide a multitude of benefits to your brain and nervous system. Adjustments activate the nerves that detect and sense motion. When those nerves are activated, it stops (or gates) the nerves that deliver pain signals. That is one of the reasons why adjustments provide pain relief. They literally “turn off” the pain sensors! Perhaps even more exciting is the emerging research that has shown adjustments can increase cortical drive. That’s a fancy way of saying researchers have found adjustments can make you stronger!  

– Your entire life is experienced through your central nervous system- every thought, memory, and action.  

– Movement of your spine can activate your central nervous system and brain

– Emerging research has shown chiropractic adjustments can help reduce pain, improve function, and even increase strength!

Next Steps:

Chiropractic care has been helping people live their best life for over 100 years. Having a higher quality of life and feeling better (with less pain) are two of the most popular reasons why people seek chiropractic care. But new research into sports performance, strength, and how the adjustment can improve brain function have a lot of people excited. We would love to hear how chiropractic care has changed your life. Stop by the front desk and tell us your story today!

Science Source:

Mechanism of action of spinal manipulative therapy. Joint, Bone, Spine 2003. Neurophysiological effects of spinal manipulation. Spine Journal 2002.

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Multiple research studies have shown that chiropractic is considered one of the most safe and effective treatments to reduce pain from your neck, low back, and more. Even if you are suffering from spinal stenosis, disc herniations, or foraminal encroachment-chiropractic may be able to help.

2 REDUCE HEADACHES
The second health benefit of chiropractic care, especially important if you have struggled with chronic headaches. Researchers have discovered that chiropractic care can reduce the frequency and intensity of headaches.

With over 20 million people suffering from headaches every day, this is a massive development in healthcare! The most common type of headaches includes; tension headaches and migraines. Tension headaches often include neck pain, muscle pain, and facial pain. Migraines are usually throbbing, can cause nausea and light sensitivity, and some even include an aura.

3 IMPROVED QUALITY OF LIFE
Many people don’t go to the doctor when they have pain. They go to the doctor when that pain interferes with their quality of life!

If you have a healthcare issue that is keeping you for enjoying your hobbies, hanging out with friends and family, and limit your ability to perform well at work- then you are likely going to start researching on Google and eventually call a doctor to get answers.

Fortunately, getting back to your active lifestyle, and improving your quality of life (or in science-speak, “functional ability”) is one proven benefits of chiropractic care.

4 REDUCED MEDICATION USE
Researchers have discovered that people who receive chiropractic care are 49% less likely to fill an opioid prescription. And, in my opinion, if we were able to reduce opioid use by nearly 50% just be helping people get well with chiropractic care- this world would be a different place!

Even what many people consider to be “safe” medications like NSAID’s contribute to over 100,000 hospitalizations, and over 3,000 deaths each year. Drugs should rarely be viewed as a first line treatment for spinal pain. Your body is designed to move and recover- so going to a doctor focused on movement and recovery seems like a good idea to not only reduce your medication use but to get the best results possible.

5 PERFORMANCE
Did you know that every major sports team in the USA has a chiropractor available to their athletes to help with injury prevention and sports performance?

That’s right, teams in the NFL, MLB, NBA, and NHL all have chiropractors integrated into their healthcare team to keep their athletes performing at their top level all season long.

No one can perform their best when in pain, so chiropractors are used to keeping the athletes feeling good, but with a focus and eye towards sport-specific performance.

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Fibromyalgia is widely viewed as a pain syndrome with an unknown cause. Sufferers will tell you a common truth though: it can be debilitating, distressing, and it’s very, very real. Sadly, the issue of how to treat this pain syndrome is no more straight-forward than finding its cause. Cognitive behavioural therapy, low-dose anti-depressants and mild exercise are often prescribed but “there is no permanent change associated with this form of treatment [1].” This often leaves sufferers feeling frustrated at the apparent permanence of their predicament.

Cranbourne North chiropractor Dr Shaun Beovich shares a case study found on the Australian Spinal Research Foundation Blog. For specific advice and care, family chiropractor Dr Shaun Beovich is experienced in dealing with Fibromyalgia. Cranbourne Chiropractic Centre services the Cranbourne North, Berwick Springs, Clyde North, Narre Warren South and surrounding areas. Book online here or call 9581 2624.

Case Reports Offer Strong Indications that Chiropractic Care May Help

A recent case study and literature review posted in the Annals of Vertebral Subluxation reveals some interesting observations on the matter. It reported on the structural and symptomatic improvements in a 40-year-old female who had suffered with the disorder for 8 years.

Hers is a demographic group that is no stranger to this disorder. It is said to affect between 2-5% of the population of the developed world. Interestingly, the vast majority of these sufferers are young to middle-aged women [2]. The symptoms of this diagnostic enigma include significant fatigue, musculoskeletal pain, cognitive disturbances and tenderness along with many other potential symptoms. Due to the fatigue elements of the disorder, many sufferers find themselves wearing a diagnostic label of ‘chronic fatigue syndrome’ though this fails to explain all their symptoms.

In the case study the patient’s symptoms included widespread musculoskeletal pain, fatigue, depression and headaches. The researchers used an initial SF 36 questionnaire to measure health-related quality of life, as well as checking her for structural misalignments or subluxations. The latter revealed an anterior head translation, left lateral head flexion, and a lateral cervical translation of 32.7mm when the ideal is 0mm. Significant segmental misalignments were noted at C3-C4, C4-C5 and C5-C6.

On her self-reported quality of life questionnaire (the SF 36), the patient’s highest scores were in the areas of role limitations due to emotional problems or physical health (50.9 and 47 respectively). When it came to general health, energy/fatigue, pain and physical functioning, she reported scores as low as 16.6, 3, 0 and 0 respectively. This illustrates the degree to which this disorder had impacted her life.

She received 44 sessions of chiropractic care over the course of 5 months using a combination of mirror image exercises, adjustments and traction.

Following the intervention, the patient’s films revealed significant improvements in subluxations. Her 32.7mm lateral cervical translation had dropped to 15.4mm and significant improvements were noted from C3-C6, restoring a lordosis to a spinal region in which she previously suffered kyphosis.

The interesting part of the case report was the quality of life scores post-intervention. The patient’s energy score had risen from 16.6 to 35. Her general health score lifted from 3 to 38. Pain and physical function rose from 0 to 38 and 36.7 respectively.

Fedorchuk et al point out that there are a number of case reports that look at fibromyalgia and chiropractic care. Their literature review, written into the case report, included details of ten other studies on the topic. In all instances, chiropractic care was employed as part of the care, and improvements were noted.

RCT Shows Upper Cervical Manipulative Therapy is Beneficial

Fedorchuk’s work, and the case reports that fed into the literature review, jog the memory back to a piece of work that may have escaped the eyes of many a chiropractor. Emerging from Cairo University and appearing in the journal Rheumatology International, the randomized controlled trial looked at the addition of upper cervical manipulative therapy to a multimodal program in treatment of fibromyalgia [3].

The study, authored by researchers Ibrahim Moustafa and Aliaa Diab, took a sample of 120 people with fibromyalgia and definite C1-2 joint dysfunction. These were randomly assigned to either a control group or an experimental group. Both groups benefited from a multimodal program involving exercise, education and cognitive behavioural therapy, whilst the experimental group also received upper cervical manipulative therapy.

The education aspect of the program included information about “typical symptoms, the usual course, medical conditions, potential causes of the illness, the influence of psychosocial factors on pain, current pharmacologic and non-pharmacological treatments, the benefits of regular exercise, and the typical barriers to behavioural change [3].” There were 12 sessions, delivered once a week in 2-hour blocks over the course of the intervention period. The same was true for the cognitive behavioural therapy aspect of the study, which concentrated on a combination of components including “educational, physical, cognitive and behavioural elements [3].” The exercise component of the program centred on a variety of relaxation techniques and stretches. All participants in the study took part in these three aspects.

The upper cervical manipulative therapy administered to the experimental group came in the form of a HVLA thrust described below:

“With the patient in the supine position, the therapist contacted the left posterior arch of the atlas with the lateral aspect of the proximal phalanx of the left second finger using a “cradle hold.” To localize the forces to the left C1-2 articulation, the secondary levers of extension, posterior– anterior shift, ipsilateral side-bend, and contralateral side- shift were used. While maintaining the secondary levers, the therapist applied a single HVLA thrust manipulation to the left atlantoaxial joint using the combined thrusting primary levers of right rotation in an arc toward the under- side eye and translation toward the table. This process was repeated using the same procedure but directed to the right C1-2 articulation.”

Additionally, the experimental group underwent low-velocity cervical joint mobilization techniques as described in Maitland [5].

The researchers used a number of outcome measures to report on baseline data and results. Outcome measures were taken after the 12-week intervention, and at 6 months and 1 year post-intervention respectively. Among the outcome measures were:

• A fibromyalgia impact questionnaire
• Rasterstereographic posture analysis
• A pain catastrophizing scale
• Algometric score
• Sleep quality
• The Beck Anxiety Inventory
• The Beck Depression Inventory

This is where it gets interesting: the results didn’t differ significantly between groups at the 12-week mark. In fact, the fibromyalgia management outcomes indicated that both of the programs were equally successful. Both groups saw some level of improvement in their symptoms, and this supported a meta-analysis showing that multicomponent treatment was effective for improving key symptoms of fibromyalgia.

However, at the one-year follow-up from this, there were “statistically significant changes that indicated that the FMS management outcomes of the experimental group exhibited continued improvement and that the control subjects’ scores regressed back toward the baseline values (i.e., the scores worsened) [3].”

The study’s authors went on to remark that, “the normalization of the afferent input of the upper cervical spine seems to offer an explanation for these one-year improved outcomes in the experimental group.” There are a number of possible explanations for the difference witnessed at the one-year mark. Among them is the possibility that the long-term effects of poor or flexed posture, or continuous asymmetrical loading and muscle imbalance may have a role – a hypothesis supported by previous research [7, cited in 3].

For a randomised controlled trial, the sample size may appear small. Given 20 of 120 people dropped out of the one-year follow up, this could appear more limiting. However, the authors indicated that this still gave them enough data for a statistically relevant change. Though not without its limitations, the results of the Cairo [fibromyalgia] study left its authors confident enough to state their belief that the results of the study should be used to introduce new guidelines for the treatment of fibromyalgia.

Although the intervention in the study was not directed specifically at subluxations, it does demonstrate the importance of a properly functioning nervous system.

How this changes the game

Up until the publication of the Cairo study, the most comprehensive literature on the matter was possibly the systemic review by Schneider et al, which was published in 2009. The lack of a comprehensive RCT left the authors of that study with the following evidence for the management of fibromyalgia: “Strong evidence supports aerobic exercise and cognitive behavioural therapy. Moderate evidence supports massage, muscle strength training, acupuncture, and spa therapy (balneotherapy). Limited evidence supports spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification [5].”

Later on, in 2011, another systemic review looked at complementary and alternative medicine in the treatment of fibromyalgia. Again, the lack of larger clinical trials left them with little evidence for spinal manipulation and other therapies like massage [6].

Moustafa and Diab’s work offers us the reliability of a clinical trial and, for the first time, statistically significant indications that the addition of upper cervical manipulative therapy can have a role. Although as with all things research-related cautious optimism is the order of the day, this study does offer a unique and valuable contribution to the evidence surrounding this condition.  We look forward to seeing further research of the impact of the subluxation on the health of those with fibromyalgia.

Read the full article at https://spinalresearch.com.au/fibromyalgia-case-study-shows-improvement-symptoms-cervical-alignments-quality-life/

References:

[1] Fedorchuk, C, Lightstone, D, Moser, J (2017), “Improvements in Symptoms, Cervical Alignment and Quality of Life in a 40-Year-Old Female with Fibromyalgia Following Chiropractic BioPhysics® Technigue: A Case Study and Selective Review of Literature,” Annals of Vertebral Subluxation

[2] Gumer, E, Littlejohn, G (2013), “Diagnostic Challenges, Fibromyalgia’ Australian Family Physician, Volume 42, No. 10, October 2013, pp 690-694, http://www.racgp.org.au/afp/2013/october/fibromylagia/

[3] Moustafa I, Diab A (2015), “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial,” Journal Rheumatology International,  https://link.springer.com/article/10.1007/s00296-015-3248-7

[4] Maitland GD, Hengeveld E, Banks K et al (2000) Maitland’s vertebral manipulation, 6th edn. Butterworth, London

[5] Schneider M, Vernon H, Ko G, Lawson G and Perera, J (2009), “Chiropractic management of fibromyalgia syndrome: a systematic review of the literature,” JMPT Vol 32, Issue 1, January 2009, pp. 25-40, https://doi.org/10.1016/j.jmpt.2008.08.012

[6] Terhost L, Schneider M, Kim K Goozdich L and Stilley C (2011), “Complementary and Alternative Medicine in the Treatment of Pain in Fibromyalgia: a systematic review of randomized controlled trials,” JMPT Vol 34, Issue 7, September 2011, pp. 483-496, http://www.sciencedirect.com/science/article/pii/S0161475411000959

[7] Mueller A, Hartmann M, Eich W (2000) Inanspruchnahme medizinischer Versorgungsleistungen. Untersuchung bei Patienten mit Fibromyalgiesyndrom (FMS) [Health care utiliza- tion in patients with bromyalgia syndrome (FMS)]. Schmerz 14:77–83 (German)

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Our bodies are designed to heal, but sometimes they need a little help. Medications and injections may mask the problem. Well, you should be happy to know that Chiropractic adjustments not only may help provide fantastic pain relief, but they also help correct the underlying problem so you can find long-term relief.

• After 2 weeks of receiving Chiropractic care, over 55% of patients experienced relief from their neck pain.
• At the 3 month mark, over 75% of patients reported experiencing significant relief.

Sitting at a desk, awkward sleeping positions, and just plain getting older can all contribute to neck pain and disc problems. Maintaining an active lifestyle by eating right, exercising, and getting periodic Chiropractic care may help your body fend off these degenerative processes. Ask Cranbourne Chiropractor, Dr Shaun Beovich today about how you can maintain a healthy lifestyle using Chiropractic care. Learning how to stay happy and healthy; that’s what we call a smart decision!

For ease and convenience, Cranbourne Chiropractic Centre located in Cranbourne North and close to Berwick and Narre Warren South takes online bookings here or you can call 9581 2624.

1. Science Sources: Outcomes from Magnetic Resonance Imaging-Confirmed Symptomatic Cervical Disk Herniation Patients Treated with High-Velocity, Low-Amplitude Spinal Manipulative Therapy. Journal of Manipulative and Physiological Therapeutics. October 2013
2. Outcomes of Acute and Chronic Patients with MRI Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity, Low-Amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study with One Year Follow-Up. Journal of Manipulative and Physiological Therapeutics. March/April 2014
3. Manipulation or Microdiskectomy for Sciatica? A Prospective Randomized Clinical Study. Journal of Manipulative and Physiological Therapeutics. October 2010
4. Symptomatic MRI-Confirmed Lumbar Disk Herniation Patients: A Comparative Effectiveness Prospective Observational Study of 2 Age and Sex-Matched Cohorts Treated with Either High-Velocity, Low Amplitude Spinal Manipulative Therapy or Imaging-Guided Lumbar Nerve Root Injections. Journal of Manipulative and Physiological Therapeutics. May 2013

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